Monday, March 31, 2014

Do More Guns Cause More Suicide?

Suicide Barriers and Gun Control

Less than three months after the Golden Gate Bridge opened, the first known suicide took place. Since then, over 1,500 people have taken their lives by jumping off the bridge, making the site one of the most popular suicide sites in the world. Calls for the construction of an anti-suicide barrier have been rejected by policymakers who argue that those committed to suicide will inevitably do so -- they will, after all, "just go somewhere else."

A famous study sought to challenge this contention, tracking 515 persons who were prevented from committing suicide at the Golden Gate Bridge. The study found that 90 ninety percent of people who were prevented from jumping off the Golden Gate Bridge did not go on to commit suicide. The findings support the idea that suicides are often "crisis-oriented" in nature, and that failed attempts often lead to a renewed commitment to living.

Despite this fact, the same bad arguments forwarded by politicians against suicide barriers are being used by the National Rifle Association to challenge gun regulation. This insistence by gun advocates that suicide is a foregone conclusion is not only factually incorrect, but incredibly dangerous because it impedes the most useful strategy for preventing suicide -- means reduction.

If barriers on bridges can significantly reduce the suicide rate, why can't barriers to accessing firearms do as well?

The Impulsiveness of Suicide

An impulsive suicide is one for which there is very little preparation prior the attempt.A 2001 study, using the Beck's Suicidal Intent Scale, examined 478 individuals who attempted suicide, and found that more than half (55 percent) of attempts could be classified as "impulsive," while only about one-sixth (17 percent) of attempts were premeditated. One study found that 40 percent of suicide attempt survivors contemplated suicide for less than five minutes before the attempt.

Another study examined self-inflicted gunshot wounds that would have been fatal in the absence of emergency treatment. The researchers found that none of the 30 individuals who attempted suicide had written a note, and more than half of them said that the thought to commit suicide occurred within 24 hours of the attempt. In a two-year follow up, none of the 30 had attempted suicide again, and the overwhelming sentiment among the group was that they were happy to be alive.

The data is clear, then, that there's nothing "inevitable" about a suicide, nothing predictable about impulsiveness. To turn a blind eye to suicide based on the pretense that they'll "just try again" demonstrates a profound ignorance of the psychology of suicide, and a callous unwillingness to consider the struggle of another human being.

The Data

The latest available data on suicide rates, published by the Centers for Disease Control, shows that 38,364 suicides occurred in the United States in 2010 -- an average of 105 each day. This made suicide the tenth leading cause of death for all age groups.

More people kill themselves with guns than all other methods combined. Males are atparticularly high risk of firearm suicide, given that guns account for 56 percent of male suicides, but 32 percent of female suicides. Firearms tend to be the weapon of choice for a suicide given their lethality factor -- for example, one study from Dallas found that, of those attempting suicide with a gun, 76 percent died.

Dr. David Hemenway of the Harvard School of Public Health summarized 10 studies in the previous 20 years examining the relationship between gun ownership and suicide and found that "all [of them] find that firearms in the home are associated with substantially and significantly higher rates of suicide."

The most recent case-control study published in the American Journal of Epidemiology found at least five reasons to believe that firearm ownership is drivingthe suicide rate:

The association between firearm availability and suicide is robust to adjustments for measures of psychopathology and aggregate-level measures of suicidality such as depression, mental illness, alcoholism, poverty, unemployment, and drug abuse.

The risk of suicide extends beyond just the gun owner to all members of a household, and lasts for years after the firearm has been purchased.

The rates of psychiatric illness and suicidal tendencies is similar in households with and without firearms across the United States.

Multiple ecological studies have confirmed the results of individual-level studies to show aggregate-level trends in suicide rates.

Suicide attempts are not significantly associated with firearm ownership rates. If it were the case that gun owners had stronger suicidal proclivities than non-gun owners we would expect the suicide attempt rate to be positively associated with the firearm ownership rate, but it isn't. This means that the primary way through which firearms influence the suicide rate is by making each attempt comparatively more lethal than other methods.

There is little controversy, then, that firearms exacerbate the suicide rate primarily by increasing the likelihood of a "successful" suicide attempt. Discussion about suicide should be at the forefront of gun control debates, yet it is often a footnote in meaningful policy discussion. This reflects poorly on our nation's priorities -- it shows a cruel insensitivity to the value of human life, and a miscalibrated sense of morality which says that change is only worth having if it benefits me.